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Forms

Forms

 

Benefits Forms
1)

Carrier Change Form

2)

Change of Name/Address Notification

3)

College Release Program and Staff Education Reimbursement Request

4)

Family Medical Leave/Parental Leave Request

5)

FMLA Authorization for the release of medical information

6)

FMLA Certification of Health Care Provider for Employee

7)

FMLA Certification of Health Care Provider for Family Member

8)

FMLA Certification of Qualifying Exigency for Military Family Leave

9)

FMLA Certification for Serious Injury of Covered Servicemember - Caregiver Leave

10)

Fitness Release Time Application

11)

Health Risk Assessment and Physical Exam Incentive

12)

Optional Retirement Plan Termination Notice

13)

Optional Retirement Program Certification

14)

Salary Reduction Agreement (ORP & TDA)

15)

Sick Leave Pool Contribution/Withdrawal Request

16)

The Edge (Staff Council Form)


Claim Forms
1)

Minnesota Accelerated Life Claim Form

2)

Fort Dearborn Disability Claim Form

3)

Minnesota Life Dismemberment Claim Form

4)

Minnesota Extended Life Claim Form

5)

Health Select Claim Form

6)

Pay Flex Claim Form


Workers' Compensation Forms
1)

Authorization for Release of Information (SORM-16)

2)

Employee's Election Regarding Utilization of Sick and Annual Leave (SORM-80)

3)

Employee's Report of Injury (SORM-29)

4)

Witness Statement (SORM-74)

5)

Supervisor Report of Accident

 

EEO Forms
1)

Veterans Status Questionnaire

 

Employment Forms
1)

Consulting and Paid Professional Service Application Form (for faculty and staff working a second job)

2)

Emergency Evacuation Assistance Form

3)

Employee Data Sheet

4)

Employment Authorization Request

5)

Fair Credit Reporting Act

6)

Internal Employment Request Form

7)

Interview Request for Faculty Candidate

8)

Interview Request for Professional Staff Candidate

9)

Job Offer Request Form

10)

Motor Vehicle Record Evaluation Request

11)

New Employee Orientation Survey

12)

Notice of Terms of Initial Appointment

13)

Personnel Recommendation

14)

Position Announcement

15)

Required Documents for New Employees

16)

Security Sensitive Position Questionnaire

17)

Student Assistant Job Announcement Form

18)

Student Worker Statement of FERPA Understanding

 

Payroll Forms
1)

Advance Authorization for Overtime

2)

Application for Leave

3)

Direct Deposit Authorization

4)

Moving and Relocation Expense Form

5)

Pay Option Form

6)

Request for Additional Compensation

7)

Time and Effort Adjustment Request

8)

Timesheet - Biweekly

9)

W4

 

Compensation/Performance Management Forms
1)

eAppraisal End-User Manual

2)

Job Analysis Questionnaire (JAQ)

 

Progressive Disciplinary Forms
1)

Notice of Verbal Counseling

 

Prior approval from ESO is required for forms # 2 through # 7
2)

Employee Written Reprimand

3)

Notice of Suspension Without Pay

4)

Notice of Dismissal from Employment

5)

Performance Improvement Plan (PIP)

6)

PIP Progress Assessment

7)

PIP Progress Assessment Instructions

 

General Forms
1)

Communication Stipend Request

2)

Business Use Only Verification

3)

HRMS PeopleSoft Operator ID Request

4)

Media Release Form

5)

Statement of Non-Compliance

 

Separation/Exit Forms
1)

Separation-Clearance Form

2)

Separation Survey

 

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Policies and Procedures

 

 

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Last updated or reviewed on 3/31/14

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